The metabolic syndrome (MS) is a multi-factorial disorder which includes a main risk factors associated with the development of cardiovascular, neurologic, renal and endocrine diseases, especially type 2 diabetes. This study has been conducted to estimate the prevalence of the MS in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and its association with cardiovascular morbidity. The study included 37 patients (25 type 2 diabetic patients and 12 non-diabetic patients), who had been on peritoneal dialysis for > 3 months. At the beginning of CAPD treatment (baseline) and at the end of follow-up, we measured: body mass index (BMI), blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (HDLC) and defined the prevalence of the MS using the modified National Cholesterol Education Program (NCEP; Adult Treatment Panel III) for peritoneal dialysis patients. The overall prevalence of the MS was 89.2%. The metabolic syndrome was estimated in all (100%) type 2 diabetic patients (vs. 60% patients on the beginning of CAPD treatment). In non-diabetic peritoneal patients, the MS was estimated in 50% cases, according to 33.3% at the beginning CAPD treatment. Development of the MS was significantly higher in the type 2 diabetic patients in compared with non-diabetic patients until the end of follow-up examination (p=0.0005). The prevalence of LVH in type 2 diabetic patients with the MS was significantly higher (p=0.002) than in non-diabetic peritoneal patients with the MS. We didn't found statistical significantly difference in the prevalence of ischemic heart disease between this two category of peritoneal dialysis patients (p=0.076). The results indicate that the metabolic syndrome is presented in high percentage in peritoneal dialysis patients, and it's also important risk factor of high cardiovascular morbidity rate in these patients, especially in type 2 diabetic patients.

A 45 year old male presented to a primary care physician with complaints of long term, bilateral knee and bilateral foot pain, without history of significant trauma. Physical exam demonstrated full range of motion without any erythema or edema. Fingernails were abnormal and hypoplastic. Bilateral knee radiographs demonstrated moderate degenerative changes of the right knee. Small, atrophic patellae were noted to be proximal to their expected location. Two months later the patient returned to his primary care physician for worsening of the knee pain related to cooler outside temperatures. An NSAID had initially relieved the pain but was becoming less and less efficacious. Alternative medications were prescribed to better control the pain. Complaints of continued knee pain and now bilateral hip pain brought him back to his physician four months later. He requested a referral to an orthopedic surgeon and an MR of the right knee was obtained. The finding showed complex tear of the lateral meniscus in patient with Nail Patella Syndrome.

The main aim of this study is to analyse causes of permanent disability of insurants of Canton Sarajevo in the period of 7 years. Following conditions were followed up: disease, occupational disease, injuries at work and not-related to work. The study included 7.136 insurants with verified loss of working ability: 4.864 males aged 51.6 (+/-7.6) years with an average achievemnt of 24.9 (+/-8.6) years of paid retirement insurance and 2.272 females aged 49.8 (+/- 6.5) years with 21.5 (+/- 7.4) years of work experience. We confirmed that the chronic disease was the dominant cause of permanent disability in the productive age group. The leading causes of disability, according to the World Health Organization International Classification of Diseases, ICD-10, are mental and behavioural disorders (36.3%) followed by diseases of the circulatory system (29.5%). Our study indicates the need for more efforts in preventive measures and more effective treatment of the mental and behavioural as well as diseases of the circulatory system in order to reduce morbidity and disability of the actively working population in the Canton Sarajevo.

Microvascular diabetic complications are the most common causes of morbidity and mortality of patients with type 1 disease. Diabetic nephropathy is becoming the single most common cause of end stage renal failure, while diabetic retinopathy is the most common cause of blindness in working-age population. The main aim of the study was to evaluate the progression of late microvascular complications in type 1 diabetic patients treated by conventional or intensified insulin regimen over the period of 10 years. We selected a random sample of 32 patients, including 14 males and 18 females, aged 30,6 +/- 11,8 years, with average duration of the disease of 4,8 +/- 3,2 years. They did not show signs of overt diabetic nephropathy, while 5 patients had background retinopathy. All the patients had their fasting and postprandial glycaemia, HbAlc, 24/hour proteinuria, blood pressure, height and weight measured and body mass index calculated (BMI). There was a trend towards increasing values of HbAlc (6.9 +/- 0.8 vs. 7.4 +/- 1.0 %, p < 0.05), fasting glycaemia (6.8 +/- 08 vs. 7.8 +/- 1.2 mmol/l, p < 0.05), postprandial glycaemia (9.2 +/- 1.5 vs. 11.3 +/- 1.9 mmol/l, p <0.01), systolic and diastolic blood pressure values (120.0 +/- 10.8 vs. 128.5 +/- 16.8 mmHg, p<0.05; and 73.4 +/- 8.1 vs. 79.8 +/- 9.8 mmHg, p< 0.05) although no hypertensive patient was diagnosed. There were 11 persons (34.4%) with persistent proteinuria of 200 mg/24 hour or more and significant difference in overall proteinuria in 10 yrs period (121.3 +/- 37.3 vs. 312.8 +/- 109.9 mg/24 h, p< 0.001). Overall, 9 persons (28.1%) were diagnosed with simple, background retinopathy, but 6 of them (18.8%) had signs of proliferative form of the disease. The results indicate significant changes in progression of proteinuria in both groups although retinopathic progression was observed but was not significant in the intensively treated group.

Osteoporosis (OP) is a generalized skeletal disorder characterized by low bone mineral density (BMD), deterioration of the microarchitecture of bone tissue and susceptibility to fracture. Most frequently it occurs in postmenopausal women and the aged. It is a chronic condition of multifactorial etiology and is a major global healthcare problem in developed and rising in developing countries. Patients with uncomplicated OP are usually asymptomatic which contributes to serious under-diagnosing of this potentially devastating condition. It is estimated that less than half of patients with OP are diagnosed in many developed countries. Therefore preventive measures and timely diagnosis have to be a key aspect of management of this disorder. In this article we briefly underline pato-physiology of the disorder, review current methods of measuring bone mineral density, describe risk factors and evaluate current and potential therapies.

ity of patients with type  disease. Diabetic nephropathy is becoming the single most com- mon cause of end stage renal failure, while diabetic retinopathy is the most common cause of blindness in working-age population. Th e main aim of the study was to evaluate the progres- sion of late microvascular complications in type  diabetic patients treated by conventional or intensifi ed insulin regimen over the period of  years. We selected a random sample of  patients, including  males and  females, aged , ± , years, with average duration of the disease of , ± , years. Th ey did not show signs of overt diabetic nephropathy, while  patients had background retinopathy. All the patients had their fasting and postprandial gly- caemia, HbAlc, /hour proteinuria, blood pressure, height and weight measured and body mass index calculated (BMI). Th ere was a trend towards increasing values of HbAlc (. ±. vs. . ± . , p < .), fasting glycaemia (. ±  vs. . ± . mmol/l, p < .), postpran- dial glycaemia (. ± . vs. . ± . mmol/l, p <.), systolic and diastolic blood pressure values (. ± . vs. . ± . mmHg, p<.; and . ± . vs. . ± . mmHg, p< .) although no hypertensive patient was diagnosed. Th ere were  persons (.) with persistent proteinuria of  mg/ hour or more and signifi cant diff erence in overall pro- teinuria in  yrs period (. ± . vs. . ± . mg/ h, p< .). Overall,  persons (.) were diagnosed with simple, background retinopathy, but  of them (.) had signs of proliferative form of the disease. Th e results indicate signifi cant changes in progression of proteinuria in both groups although retinopathic progression was observed but was not sig- nifi cant in the intensively treated group.

INTRODUCTION The main metabolic defect responsible for hyperglycaemia in type 2 diabetes is insulin resistance and impaired B-cell function. Currently much more medications which combat impaired B-cell function are available then those which might inhance insulin sensitivity. A novel oral hypoglycaemic agent, rosiglitazone, targeting insulin resistance, not yet registered in our country, has been available in majority of Europian countries. The main aim of the study was to evaluate the efficacy of rosiglitazone in the treatment of patients with type 2 diabetes patients compared with glibenclamide monotherapy. METHODS A total sample of 20 diabetic patients, who had not achieved satisfactory control with dietary modifications, was selected. 10 patients were randomised to rosiglitazone treatment in daily dosage of 4 to 8 mg (RG group) while the rest of the patients were receiving glibenclamide in the dosage of 3.5-10.5 mg daily (GC group). All the patients had their fasting and postprandial glycaemia, HbAlc, fasting insulin and blood pressure measured at baseline and 3 months after initiation of the treatment. Possible increase of the liver enzymes in the RG group was followed up. RESULTS There was a significant reduction in glycaemic parameters in both groups in comparison to baseline values. However fasting insulin levels in the RG group were significantly reduced while slight but not significant increase was noted in GC group. Blood pressure values were significantly reduced in the RG group while no changes were noted in the GC group. CONCLUSION Results indicate significant improvement of glucose utilisation as a consequence of reduced insulin resistance in the RG group. Treatment with rosiglitazone lead to improved insulin sensitivity which may predict longer term preservation of B-cell function. In addition, this novel agent also have favourable impact to blood pressure values which is of exceptional importance in the complex management of type 2 diabetic patient.

BACKGROUND Cardiovascular diseases represent the leading cause of mortality in patients with end-stage renal disease treated by hemodialysis. Left ventricular hypertrophy (LVH), which is connected with various risk factors present in this population of patients, represents a major factor of high mortality. AIM To determine the plasma levels of parathormone (PTH, levels of serum calcium (Ca) and phosphorus (P) in patients treated by hemodialysis, and investigate the impact of PTH as a possible risk factor for LV morphology changes. PATIENTS AND METHODS The study included 50 patients with end-stage renal disease during the first two years of haemodialysis treatment. They were followed during the period of 12 months and had the same conditions of hemodialysis treatment. All participans have the echocardiography performed, as well as serial measurements of serum calcium and phosphorus by standard laboratory tests, and measurement of PTH by immunoradiometry. RESULTS More than 2/3 of selected patients (72%) showed signs of LVH at the beginning of the study. Patients with concentric LVH have significantly higher levels of PTH than those with normal echocardiography finding. Especially high levels of PTH were observed in patients with global sistolic-diastolic LV failure (more than 84,5% than the patients with normal echocardiography). PTH is significantly and independently associated with LV mass (p=0,002) and LV volume increment (p=0,040) noted by echocardiography. Ca x P product showed higher values in patient with sistolic-diastolic LV failure as compared to patients with normal LV echocardiography. CONCLUSION PTH appears to be an independent predictor of significant changes in LV mass and volume, which indicates that this "uremic toxine" has the importance of risk factor for uremic cardiomiopathy.

The aim of this study was to assess working ability of persons suffering from some of essential hypertension (EH) complications in Canton Sarajevo in the period of two years (01.01.1998-31.12.1999). Recorded complications included: congestive heart failure (CHF), heart attack (HA), angina pectoris (AP) and cerebrovascular disease (CVD). The study included 606 persons with EH with clinically verified complications, out of whom there were 416 males of average age of 53.4 (+/- 14.7) years, and 190 females of average age of 50.3 (+/- 12.8) years. There were 377 (62.2%) persons assessed with complete loss of working capability, 126 (20.8%) with limited working capability and only 103 (16.9%) were found without disability in regard to the tasks required in their job description. It was confirmed that EH complications have significant impact to disability among insurants in their most productive working age. CHF is the leading cause of complete loss of working capability, particularly in the group of labour workers with low qualification structure, followed by CVD, HA and AP. Disability-loss and limited working capability was dependant on sex, age, type of complication, qualification structure and the type of occupation. The results of this study indicate urgent need for establishing a more efficient concept of primary prevention as well as better and comprehensive treatment of the EH in order to reduce morbidity and disability among the working age population.

INTRODUCTION Without sufficient insulin treatment, acceptable level of glycoregulation, avoidance of dislipoproteinaemia and maintenance of body mass is difficult to achieve in patients with type 1 diabetes mellitus (DM). On the other hand sometimes it is difficult to prevent weight gain, endogenous hyperlipidemia and iatrogenic insulin resistance. AIM To compare metabolic control indicators in patients with type 1 DM in patients treated conventionally to those on intensified insulin regimen. MATERIAL AND METHODS A sample of 52 persons with type 1 DM, without late complications and long duration of the disease, was selected. Among them 19 (36.5%) persons were treated with insulin in 4 or 5 doses, and 33 (63.5%) conventionally, in 2 doses. All the participants had biochemical indicators of metabolic control determined (glycosylated Hb , fasting and postprandial glycaemia, total cholesterol, triglycerides as well as lipoprotein fractions, HDLC and LDLC), body height (BH) and weight (BW) measured, body mass index calculated (BMI) and blood pressure measured (BP). RESULTS In the group treated conventionally we found significantly higher mean values of BMI as compared to those on intensified insulin treatment (23.2 +/- 2.0 kg/m2, and 21.2 +/- 1.2 kg/m2 respectively, p%<0.01) and proportion of those with overweight was as well significantly higher (27.3% versus 0%, p =0.012). We noted higher mean values of systolic (134.2 +/- 17.6 mmHg, versus 123.4 +/- 12.7. p<0.05) and diastolic (83.2 +/- 10.1, versus 74.0 +/- 9.7, p<0.01) BP. Biohemical indicators of glycoregulation were significantly worse with, at the same time, higher total dose of applied insulin ( 55.9 +/- 8.5 IU, versus 46.3 +/- 10.0 IU, p<0.01), and insulin units per kg of body weight (0.84 +/- 0.11 IU/kg versus 0.77 +/- 0.15 IU/kg, p<0.05). CONCLUSION Results indicate that intensified insulin treatment is more favourable variant of treatment, by which the certain level of insulin resistance, which might be present in patients treated with two higher insulin doses, is probably reduced. Therefore it improves metabolic outputs, blood pressure values and body mass index but also may have beneficial impact to economic aspect of insulin treatment as well.